Abdominal Wall Reconstruction with a Free Fibula Flap after Internal Extended Hemipelvectomy.

Major pelvic resections for malignant tumors are infrequent and have significant morbidity and mortality, for instance, incisional hernias are postoperative complications uncommonly reported probably because most cases are overshadowed by more serious complications. Reconstruction depends on the extent of the resection and overall prognosis of the patient. A case of a late complex hypogastric and femoral incisional hernia after extended hemipelvectomy for recurrent osteosarcoma treated with distal abdominal wall fixation into a free fibula flap is reported.

Levator Palpebrae Superioris Muscle Direct Neurotization.

Direct muscle neurotization has been proved to be a feasible technique for facial reanimation microsurgical procedures. Direct muscle neurotization is performed by implanting the interposition nerve graft directly into the substance of the muscle. The authors present the case of a 36-year-old male patient with upper eyelid dysfunction secondary to facial trauma. The levator palpebrae superioris muscle was macroscopically unaffected; however, neurophysiological test proved a selective denervation of the CN III motor branch to the levator palpebrae superioris muscle. Direct muscle neurotization was performed by means of 2 separate nerve procedures. The authors have made follow-up for 3 months after surgery. The authors have noted development of upper eyelid movement meaning adequate function of the neurotized muscle. The authors believe that this procedure could be integrated into the surgical options to treat selective nerve injuries should the right patient is encountered.

Treatment of Neuroma of the Dorsal Branch of the Ulnar Nerve With Transfer to the Distal Anterior Interosseous Nerve.

Painful neuromas of the dorsal branch of the ulnar nerve may be difficult to treat. Proximal transposition is the standard treatment, but pain may recur. Sensory-to-motor nerve transfer as an evolution of targeted muscle reinnervation is a recently described technique to reduce neuroma formation in the treatment of painful neuromas. This report describes sensory-to-motor transfer of the dorsal branch of the ulnar nerve to the distal anterior interosseous nerve to treat a painful neuroma.

[Hypothyroidism incidence after multimodal treatment for laryngeal cancer]. / Incidencia de hipotiroidismo secundario a tratamiento multimodal en cáncer de laringe.

BACKGROUND: Hypothyroidism following total laryngectomy or radiotherapy treatment for laryngeal cancer is not a rare event, especially in advanced stages. There are no reports on the incidence of hypothyroidism in patients who received chemotherapy and radiotherapy. The objective of this study is to determine the incidence of thyroid dysfunction in a group of patients with laryngeal cancer who underwent surgery as sole treatment, total laryngectomy or radiotherapy alone, and patients with combined treatment: surgery plus radiotherapy, concomitant chemoradiation therapy and chemoradiation therapy plus salvage surgery. METHODS: A prospective study of patients diagnosed with laryngeal cancer whose serum TSH and T4 levels were evaluated in a serial fashion. RESULTS: 70 patients with laryngeal cancer were studied; the average age at diagnosis was 70.2 years. Male patients were more affected, with a men-women ratio of 3.6:1. Glottic localization was the most frequent (44%). 64% of tumors were locally advanced carcinomas and 51% received multimodal treatment. 45 patients (63%) were diagnosed with hypothyroidism; 49% of the patients with subclinical hypothyroidism, and 51% with clinical hypothyroidism. CONCLUSIONS: Hypothyroidism is a complication following treatment for laryngeal cancer. It is recommended to evaluate the thyroid function periodically for timely detection.

[Association of three anatomical variants of the anterior cerebral circulation]. / Asociación de tres variantes anatómicas de circulación cerebral anterior.

BACKGROUND: As part of a study of the microsurgical anatomy of the pericallosal artery, we describe one brain with three unusual anatomical variants. METHODS: From the autopsy of a 45 year-old female, we extracted the brain and all the arterial blood vessels were washed off with saline solution to be injected afterwards with red latex. The brain was then immersed in 10% formalin for two months. Finally, we dissected and measured the internal carotid artery segments, using a digital Vernier caliper under a Carl Zeiss OPMI surgical microscope with magnification of 6x up to 40x. RESULTS: The brain's weight was 1250 grams and three rare anatomical variants were found: 1) right accessory middle cerebral artery (ACMA-d), 2) right bihemispheric anterior cerebral artery (ACABihem-d), 3) median artery of the corpus callosum (AMCC). CONCLUSION: The association of the anatomical variations described previously is inconstant; furthermore, their appearance in a single case is rare.